Lesson 1, Topic 11
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Wandering atrial Pacemaker

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ECG Findings:

  • Variable amplitude and/or morphology of the P wave
  • The change in P wave amplitude and/or morphology tends to gradually shift from normalcy
  • It occurs in association with sinus arrhythmia
Wandering Atrial Pacemaker in a dog – slide to hightlight varying P wave amplitude


  • Associated with increased vagal tone
  • Due to shifting of the point of origin of depolarization within the complex sino-atrial node structure
  • Usually a normal finding


  • None
  • In the face of a marked sinus arrhythmia, altered P wave morphology may be misinterpreted as atrial premature beats

Treatment: None required

Wandering Atrial Pacemaker